Falciparum malaria increases in the UK

12 Jul 2008

Paul Chinnock

Source: BMJ (see original article)
Source: BBC (see original article)

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About a dozen people now die in the UK every year as a result of malaria caused by Plasmodium falciparum. This is a tiny fraction of the estimated one million deaths that occur globally but attention given by the international media to new figures, published by the UK’s Health Protection Agency (HPA), is justified for two reasons. First the increase in the number of cases over the last 20 years highlights the global spread of malaria and second it underlines the risks to travellers who wrongly believe themselves to be at least partially immune to malaria.

In the period 1987-91 there were 9,891 cases of malaria reported in the UK, all among people who had recently travelled to areas where malaria was endemic. In the period 2002-06, the total number of cases was lower – 8,836. However, the number of cases due to the more serious P. falciparum had increased by around 30% from 5,120 to 6,753. There were 35 deaths during 1987-91 and 48 in 2002-06. The fatality rate among falciparum cases thus remained fairly constant. The decline in the total number of malaria cases is the result of a marked drop in the number due to the less serious P. vivax.

Quoting from the HPA study, as published in the BMJ: ‘Travellers visiting friends and relatives, usually in a country in Africa or Asia from which members of their family migrated, accounted for 13 215/20 488 (64.5%) of all malaria reported, and reports were geographically concentrated in areas where migrants from Africa and South Asia to the UK have settled. People travelling for this purpose were at significantly higher risk of malaria than other travellers and were less likely to report the use of any chemoprophylaxis.’

Those visiting West Africa are at particular risk; travel to Nigeria and Ghana accounted for 54% of all imported P. falciparum.

Professor Peter Chiodini, head of the HPA’s Malaria Reference Laboratory, said: ‘There is a prevailing myth that travellers who were born in a malaria-endemic country such as Africa have some ‘natural’ immunity to malaria and this is simply not the case. Like all other people who go to Africa and Asia they need to make sure they take their anti-malaria drugs and follow the guidelines that are there to protect everyone.’

The conclusions of the published study are that: ‘Provision of targeted and appropriately delivered preventive messages and services for travellers from migrant families visiting friends and relatives should be a priority.’